I want to share half of the reason I’m in the profession that I’m in. I always find joy when I hear or see someone being appreciated or recognized, especially when it’s unexpected.
I would like to feel a similar sense of joy when I think about how Physical Therapy is viewed in our society. Instead, it upsets me that our profession is so underused and underappreciated.
This blog is about the influence of medicine on older adults and what we can do to help our patients get past that. The best way to illustrate this is through two of our recent patients.
Example 1: A gentleman who had back and knee pain was waiting for a total knee replacement, and yet we were able to replicate some of his knee symptoms through back movements. He went through the evaluation and I worked with him on a program; however, near the end of the first session he made one of those “light bulb” statements. He said, “I am sure what you have given me may help, but I’m slated for a total knee that I know will fix my problem. My doctor told me it would.”
I’m sure you can guess the rest.
He didn’t do the exercises and said he would prefer to wait for the surgery. He got the surgery a couple months ago and low and behold he is no better, he is worse. Yet, his doctor told him to give it a year. So now this gentleman who was walking without any device is in a wheelchair and wants to wait on any Physical Therapy as his doctor suggested.
Example 2: The next gentleman had back pain so bad that he could not stand up. He said his doctor took x-rays and he was told he had severe arthritis and that he would be getting an MRI in a couple days. We assessed him and explained that most people have positive x-rays by the age of 60. Yet many have no symptoms or functional deficits. Getting the muscles to the proper length and strength could provide tremendous relief. I asked him if he was willing to try an exercise program just for a few days and to note if he felt any better. I explained that it might take longer for complete relief, but he should feel some relief after a few sessions. He agreed to give it a try. After our first visit, he told me he was standing up straight for the first time in months and that he would definitely continue the program. It has only been a couple of weeks, but he feels so good he wants to get back to tennis.
So what is the difference?
Some call it “medical myopia”, or a type of short sightedness when it comes to medical options. Our patients go to the doctor and the doctor leads them to believe that they have a pathology that can only be fixed with surgery or medication, or that it is a chronic condition for which nothing can be done.
Please do not take that as someone who doesn’t appreciate physicians. We work with many of them. Like our profession, theirs is growing so fast that they can’t possibly keep up with every bit of medical research, so they do the best they can and typically use a more medication/surgically based approach.
We may feel that physicians should already know about the impressive results physical therapists produce and the lack of side effects stemming from PT. Why do physicians rely on drugs so much and PT so little?
There aren’t any PT reps like there are drug reps. It’s up to us to keep physicians updated about our profession. Frankly, I think we can learn a thing or two from pharmaceutical companies about how to go about this task.
Pharma reps, whose job it is to inform physicians and encourage specific prescribing behavior, are told “Physicians want to see fewer product refreshers, more patient first content.” For PTs, that means sharing research about the benefits of PT protocols on specific medical conditions.
Working with patients who are uncertain about therapy is very difficult. There may not have been anything I could have done for the first gentleman. I did try, but he was completely sold on the idea that surgery would solve his problem. Here is what I have found to be most successful.
- Leading with the evidence. For example, Telling patients about a study of 103 people who showed significant improvement in balance after completing a high intensity training program.
- Providing examples of people who were successful.
- Asking for a short-term commitment to see if you get results.
- Explaining why what I suggest works.
We have so much to offer, especially now that adults are living longer. My goal is to educate society on the benefits of Physical Therapy.
